RMA Request

RMA REQUEST

"*" indicates required fields

First Name*

Last Name*

Company*

Phone*

Email*

RETURN SHIPPING INFORMATION*

QIII UNIT INFORMATION*

Serial Number 8 or 10 digit number located on the back of your unit.

QIII MODEL*

REASON FOR RETURN*

Acknowledgement of Obligation and Decontamination Certification

By accepting authorization to return this product to Pentagon Technologies, the customer/user hereby assumes all responsibility and liability for, and holds harmless and releases Pentagon Technologies from liability for; biological, chemical and radiological decontamination and cleaning of the product(s) and/or packaging associated therewith.

Hazardous Materials and/or Environment*

Check this box if the product subject to the Return Authorization WAS NOT subjected to hazardous materials and/or environment.

Check this box if the product subject to the Return Authorization WAS subjected to biological, chemical, radiological, or other hazardous material and/or environment and has been appropriately decontaminated, and the decontamination has rendered the product safe for handling. If this box is checked, please fill in known contaminate(s) and Cleaning Agent(s) used.

Known Contaminant(s)

Cleaning Agent(s) Used

REPAIR DETAILS

A - Unit doesn't boot up

B - System won't zero count

C - System won't count

D - Touchscreen doesn't work

E - Probe doesn't work

F - Other

G - No Repair

ADDITIONAL INFORMATION

Name

This field is for validation purposes and should be left unchanged.

RMA Request

RMA REQUEST

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